Provider Demographics
NPI:1669741138
Name:MANNIX, LISA KAYE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KAYE
Last Name:MANNIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7908 CINCINNATI DAYTON RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6602
Mailing Address - Country:US
Mailing Address - Phone:513-777-4999
Mailing Address - Fax:513-777-4309
Practice Address - Street 1:7908 CINCINNATI DAYTON RD
Practice Address - Street 2:SUITE J
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6602
Practice Address - Country:US
Practice Address - Phone:513-777-4999
Practice Address - Fax:513-777-4309
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350713262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG59065Medicare UPIN